Sometimes, states face emergencies: situations where many individuals face an imminent threat of serious harm. Some believe that in such cases certain sorts of actions which are normally morally prohibited might be permissible. In this paper, I discuss this view as it applies in both the contexts of war and of public health policy. I suggest that the deontologist can best understand emergencies by analogy with the distinction between act- and rule consequentialism. In real world cases, we must (...) often make decisions in ‘epistemically murky’ situations, such that the application of deontological principles to particular cases is unclear. I suggest that we develop conventions to deal with such cases in a manner which we think is most likely to approximate the demands of abstract deontological principles across time. I claim that we can best understand ‘supreme emergencies’ as situations which ‘epistemic murkiness’ is resolved. In such cases, there may be a conflict between what would be valid application of abstract deontological principles and the conventions which normally guide us in epistemically murky situations. (shrink)

Do we have stronger duties to assist in emergencies than in nonemergencies? According to Peter Singer and Peter Unger, we do not. Emergency situations, they suggest, merely serve to make more salient the very extensive duties to assist that we always have. This view, while theoretically simple, appears to imply that we must radically revise common-sense emergency norms. Resisting that implication, theorists like Frances Kamm, Jeremy Waldron, and Larry Temkin suggest that emergencies are indeed normatively exceptional. While their (...) approach is more in line with common-sense, however, it is theoretically less simple, and it is has proven difficult to justify the exception. In this paper we propose a model of emergencies that we call the Informal-Insurance Model, and explain how this can be used to combine theoretical simplicity with common-sense emergency norms. (shrink)

Volume 20, Issue 7, July 2020, Page 101-103.

The three primary ethical challenges in preparing for public health emergencies - addressing questions of rationing, restrictions and responsibilities - all entail confronting uncertainty. But the third, considering whether people and institutions will live up to their responsibilities in a crisis, is perhaps the hardest to predict and therefore plan for. The quintessential example of a responsibility during a public health emergency is that of health care professionals' obligation to continue caring for patients during epidemics. Historically, this 'duty to (...) treat' has sometimes gone unrecognized or ignored, but it has also famously been adhered to, including during the recent SARS epidemic. And non-crisis examples of health professionals working in the face of personal risk are very common. The duty to treat should be circumscribed by several considerations, including the levels or risk and benefit at issue, the degree of public reliance on health professional action, and the nature of the individual health professional's acceptance of greater than usual risk. Examining the professional duty to treat and the legitimate questions it raises can provide insight into other actors' responsibilities. Public health ethics as well as professional ethics can help frame answers to some key questions: How strong are ethical responsibilities during crises? To whom do they apply? Should they be more explicit - and hence more circumscribed - or less explicit and hence largely aspirational? And how can public health policies encourage responsible actions? (shrink)

In this article, I seek to make sense of the oft-invoked idea of 'public emergency' and of some of its (supposedly) radical moral implications. I challenge controversial claims by Tom Sorell, Michael Walzer, and Giorgio Agamben, and argue for a more discriminating understanding of the category and its moral force.

Responses to public health emergencies can entail difficult decisions about restricting individual liberties to prevent the spread of disease. The quintessential example is quarantine. While isolating sick patients tends not to provoke much concern, quarantine of healthy people who only might be infected often is controversial. In fact, as the experience with severe acute respiratory syndrome (SARS) shows, the vast majority of those placed under quarantine typically don't become ill. Efforts to enforce involuntary quarantine through military or police powers (...) also can backfire, stoking both panic and disease spread. Yet quarantine is part of a limited arsenal of options when effective treatment or prophylaxis is not available, and some evidence suggests it can be effective, especially when it is voluntary, home-based and accompanied by extensive outreach, communication and education efforts. Even assuming that quarantine is medically effective, however, it still must be ethically justified because it creates harms for many of those affected. Moreover, ethical principles of reciprocity, transparency, non-discrimination and accountability should guide any implementation of quarantine. (shrink)

Despite Kant's explicit statement that every murderer must suffer death, there are at least four situations to be found in Kant's work in which the killing of a human being should not lead to the death penalty: when too many murderers are involved; when a mother kills her illegitimate child; when one duellist kills the other; when one person pushes another off a plank in order to save his life. This paper discusses these situation and concentrates on the last situation (...) - Kant's interpretation of the plank of Carneades – with an eye to what they learn us about Kant understanding of the law. Does Kant acknowledge a legal vacuum? In order to come to a conclusion, Kant's 'solution' of the plank is compared with those suggested by other authors, such as Cicero, Pufendorf and Lon Fuller in his famous 'speluncean explorers' case. (shrink)

Life threatening emergencies involving infants and children are inherently dramatic, tension-filled situations. It is no wonder, then, that depictions of such events can be found in literature by and about doctors. In many ways, too, such depictions can illuminate key aspects of such events, such as the physician's own anxiety and the tensions between the various people involved, better than the medical literature. Hence it is suggested that the study of literary depictions of pediatric emergencies might be a (...) useful adjunct for those, physicians and other health care providers, who are called upon to manage them. (shrink)

Thomas Hobbes might seem an unlikely source for a theory of emergency powers applicable to liberal democracies in our own day. He advocated the concentration of political, judicial, economic and military authority, and was in favour of great latitude for a monarch or assembly in the choice of means to security. His theory demands absolute submission to law on the part of citizens, with no constitutional limitations on what laws can require. 1 The same theory demands preventive measures against sedition, (...) and has a very expansive conception of seditious behavior. What is more, the concentration of power with wide discretion is supposed to be politics as usual. (shrink)

Rights theorists tend to take tempi pacifici for granted, but it is precisely in emergencies that rights are most difficult to protect and most in need of protection. Two remedies are: first, to be successful in emergencies and second, to establish a free government capable of handling emergencies. These remedies play no role in the thinking of the ACLU, which has increasingly come to define the public's understanding of rights. For the ACLU, a right is not a (...) right unless it can be carried to an extreme and used irresponsibly. A better liberal theory, with instruction from Machiavelli, will seek to combine our interest in security with our assertion of rights. (shrink)

Although Jonathan Herington, Angus Dawson, and Heather Draper offer valuable insights on how to conceptualize health hazards and understand their effects on populations, I resist the label “public health emergency” for obesity, and here is why. It is important—politically and pragmatically—to be judicious with words that have legal and real‐world consequences. Once a concept is stretched to encompass a broad swath of events, it loses its power. The broader the application of the term “public health emergency,” the more it loses (...) the core idea of an emergent event. Thus, framing a long‐simmering health hazard such as obesity as an emergency would mute the voices of public health authorities seeking a surge response to a truly emergent event, such as a rapidly spreading novel disease or a natural or man‐made disaster. (shrink)

This article addresses an important, overlooked regulatory challenge during global health emergencies. It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively (...) capturing these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines—which draw upon practical examples of guidelines ‘in action’—that assist in determining how to act in a particular situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples—which incorporate important lessons learned—illustrate how such guidelines can be interpreted at a practical level. (shrink)

abstract Assume that some group, A, is under a serious threat from some other group, B. The only way group A can defend itself is by using lethal force against group B, but the standard conditions for using force in self‐defence are not met. Ought group A to avoid the use of force even if this means yielding to an aggressive, evil power? Most people would resist this conclusion, yet given the violation of essential conditions for self‐defence, this resistance is (...) hard to justify. The aim of this paper is to point to an interesting yet unnoticed move made by some philosophers to find a way out of this problem, a move which relies on construing the situation at hand as a tragic dilemma. I show the attractiveness of this solution and argue that in the end it fails. (shrink)

Global health emergencies often lead to a proliferation of health-related research and resultant data, which is shared across borders to help control the outbreak of disease and support decision-making regarding public health interventions. However, efforts to share data can be hindered by diverse international ethical and legal frameworks. The frameworks aim to govern coordinated processing, sharing and transfer of health data across borders thus placing burdens on researchers who are willing or obligated to share data. In this paper, we (...) investigate ethical values and legal principles that can be applied to ensure a more streamlined approach in the governance of cross-border health data sharing during global health emergencies. A scoping review approach was used to better understand emerging evidence about issues related to the ethical and legal governance of cross-border health data sharing. We first highlight the challenges of sharing health data across borders. We then discuss how the challenges might be overcome through the application of ethical values and legal principles that have been identified in literature. This is followed by a proposal for possible ways of streamlining the governance of health data sharing from ethical and legal perspectives in a bid to better prepare for future global health emergencies and promote the responsible sharing of health data. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spirometer, Whale, Slave:Breathing Emergencies, c. 1850John Durham Peters (bio)Breath dramatically starts with a slap at birth and ceases with death and yet we typically ignore it until it is under duress. Unlike marine mammals such as whales and dolphins who can never fully automate breathing—they sleep one brain hemisphere at a time so as to keep conscious watch, like yogis, over their respiration—we humans are mostly somnambulists with (...) regard to breath. Unlike our briny cousins, we won't drown if we neglect our breath. Our relatively accommodating habitat at the fold of lithosphere and atmosphere enables a Lethe of oblivion, though many elements of our world are hostile to breath: water, fire, earth, extremes of height, heat, or cold. Nothing could be more fundamental for aerobic terrestrial creatures than breathing. So its routine cloaking in impercipience must somehow be functional and require a great deal of nervous expenditure. (It always takes a lot of work to make an infrastructure invisible.)Breathing is a good test case for the notion, common to many variants of critical theory, that nature for humans is always second nature: what would it mean to find culture, history, and politics in something that is so relentlessly universal and given? The intensity of the urge for drink, food, sex, or sleep pales compared to that of taking a breath withheld or expelling a breath too long held. Here, it seems, desire and need converge. Breathing morphs into awareness, art and artifice when threat, absence or curiosity rouse it from its slumber—when we swim, have a coughing fit, sing, or challenge someone to a breath-holding contest. Under the earth in a mine, high in the air on a mountain or airplane, ill with a respiratory disease, or in other extreme situations, we need techniques and technologies to breathe. Like everything supposedly natural, we can't leave breathing in peace. We mold breath in techniques of speech, song, and prayer and in technologies of diving, medicine, and air travel. A full accounting of such would form a full encyclopedia of human ingenuity.1 [End Page 85]With typical flamboyance, Peter Sloterdijk declared that the atmosphere first ceased to be taken for granted, i.e., became technical, a matter of art, on 22 April 1915, with the German deployment of poison gas in World War I. On a world-historical scale, he takes this weaponization of the environment as an "air-quake" that launched modern air-conditioning in its most literal sense of climatization (as French and German has it) and not just interior cooling (Sloterdijk 89-110 passim). We need a history of comparative breathing emergencies! Every era, like every life, has its encounters with the precarity of breathing, even if not as conveniently dated or climate-change prognostic as 22 April 1915. The urban concentration of human population starting a few thousand years ago, for instance, made people co-breathers (con-spirators) in new ways and thus more prone to the contagious respiratory illnesses that have long ravaged our species.I want to look at one such moment—one marked by a deadly global respiratory illness, new instruments for producing data, worries about radical alterations to the atmosphere, comparative interest in nonhuman forms of life, and the politicization of breathing. 1850, like 2020, was a moment when breath awoke from its autonomic quiet. The nineteenth century was the great age of tuberculosis, the tragic and romantic lung disease. It was a time of fog, smoke, and mud, of climate-changing volcanic eruptions and a year without a summer, and of a mysterious, brooding "storm-cloud" that John Ruskin complained of so bitterly. Medical instruments, the whaling industry, and struggles for the abolition of slavery all brought the lungs into the foreground.SpirometerThe nineteenth century was also the great age of instrumentation. Light and sound were only the two most famous dynamic processes to yield to new graphic methods of inscription such as photography and phonography. The spirometer was one of many devices designed to render visual data of physiological functions, such as the myograph, the flame manometer, sphygmomanometer, and the kymograph. Many of them are still in use. The invention... (shrink)

What characterizes emergency today is the proliferation of the term. Any event or situation supposedly has the potential to become an emergency. Emergencies may happen anywhere and at any time. They are not contained within one functional sector or one domain of life. The substantive focus of the articles collected in this special issue reflects this proliferation: they explore ways of governing in, by and through emergencies across different types of emergencies and different domains of life. In (...) response to this proliferation, the issue opens up critical work on the politics of emergency beyond the ‘state of exception’ as dominant paradigm. Emergency is treated as a problem for government that calls for the invention of new techniques or the redeployment of existing techniques. Through this shift in emphasis, the articles in this issue disclose relations between modalities of power and emergency life that differ from the ‘lightening flash’ of a sovereign decision on the exception taken from outside of life, or the capacity to ‘mould’ an always-already emergent life from within life. (shrink)

Making research data readily accessible during a public health emergency can have profound effects on our response capabilities. The moral milieu of this data sharing has not yet been adequately explored. This article explores the foundation and nature of a duty, if any, that researchers have to share data, specifically in the context of public health emergencies. There are three notable reasons that stand in opposition to a duty to share one’s data, relating to: (i) data property and ownership, (...) (ii) just distribution of benefits and burdens and (iii) the contemporary ethos of science. We argue each reason can be successfully met with corresponding rationale in favour of data sharing. Further support for data sharing has been echoed in policies of health agencies, funding bodies and academic institutions; in documents on the ethical conduct of biomedical research; and in discussions on the nature of public health. From this, we ascertain that sharing data is the morally sound default position. This article then highlights the key roles reciprocity and solidarity play in supporting the practice of data sharing. We conclude with recommendations to regard public health research data as a common-pool resource in order to build a framework for stable data sharing management. (shrink)

Widespread obesity poses a serious challenge to health outcomes in the developed world and is a growing problem in the developing world. There has been a raft of proposals to combat the challenge of obesity, including restrictions on the nature of food advertising, the content of prepared meals, and the size of sodas; taxes on saturated fat and on calories; and mandated “healthy-options” on restaurant menus. Many of these interventions seem to have a greater impact on rates of obesity than (...) does simply providing information about health risks and healthier lifestyles. The more interventionist policy options have, however, been implemented only slowly, in large part because of criticisms that they are unjustified infringements on the liberty of consumers. Food industry groups, free-market think tanks, and the popular press regard measures that incentivize or penalize particular food and lifestyle choices as unjustifiable state regulation of purely self-regarding behavior. To counteract the liberty-oriented position, those who favor a more interventionist role for the state have recently argued for labeling obesity as a public health emergency. By labeling obesity as a public health emergency, policy-makers could override concerns about individual liberty in order to pursue more interventionist policies designed to guide consumer choices toward healthier lifestyles. In this paper, we argue that, contrary to initial appearances, obesity possesses some of the morally relevant features of public health emergencies, though we do not argue that it actually constitutes one. (shrink)

Disasters and public health emergencies raise a variety of ethical dilemmas, often including those that require balancing the best interests of individuals against those of groups or communities. The on-going COVID-19 pandemic provides examples of these ethical conflicts, as do other recent outbreaks. Decisions and actions in this context must address different ethical issues, ranging from those directly related to autonomy, consent, privacy and confidentiality to those related to interventions and technologies, such as efficacy, effectiveness, safety and fair access. (...) This paper aims to identify ethical conflicts with complex resolutions involving aspects related to values, rights and needs of individuals and the collective, and to suggest how such challenges could lead to more positive experiences and outcomes when confronted in future emergencies. (shrink)

Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. The current study aimed to examine: [1] risk factors (...) associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment. (shrink)

Background The COVID-19 pandemic forced governments, multilateral public health organisations and research institutions to undertake research quickly to inform their responses to the pandemic. Most COVID-19-related studies required swift approval, creating ethical and practical challenges for regulatory authorities and researchers. In this paper, we examine the landscape of ethics review processes in Africa during public health emergencies (PHEs). Methods We searched four electronic databases (Web of Science, PUBMED, MEDLINE Complete, and CINAHL) to identify articles describing ethics review processes during (...) public health emergencies and/or pandemics. We selected and reviewed those articles that were focused on Africa. We charted the data from the retrieved articles including the authors and year of publication, title, country and disease(s) reference, broad areas of (ethical) consideration, paper type, and approach. Results Of an initial 4536 records retrieved, we screened the titles and abstracts of 1491 articles, and identified 72 articles for full review. Nine articles were selected for inclusion. Of these nine articles, five referenced West African countries including Liberia, Guinea and Sierra Leone, and experiences linked to the Ebola virus disease. Two articles focused on South Africa and Kenya, while the other two articles discussed more general experiences and pitfalls of ethics review during PHEs in Africa more broadly. We found no articles published on ethics review processes in Africa before the 2014 Ebola outbreak, and only a few before the COVID-19 outbreak. Although guidelines on protocol review and approval processes for PHEs were more frequently discussed after the 2014 Ebola outbreak, these did not focus on Africa specifically. Conclusions There is a gap in the literature about ethics review processes and preparedness within Africa during PHEs. This paper underscores the importance of these processes to inform practices that facilitate timely, context-relevant research that adequately recognises and reinforces human dignity within the quest to advance scientific knowledge about diseases. This is important to improve fast responses to PHEs, reduce mortality and morbidity, and enhance the quality of care before, during, and after pandemics. (shrink)

Biobanking can promote valuable health research that may lead to significant societal benefits. However, collecting, storing and sharing human samples and data for research purposes present numerous ethical challenges. These challenges are exacerbated when the biobanking efforts aim to facilitate research on public health emergencies and include the sharing of samples and data between low/middle-income countries (LMICs) and high-income countries (HICs). In this article, we explore ethical challenges for COVID-19 biobanking, offering examples from two past infectious disease outbreaks in (...) LMICs where biobanking activities contributed to the perpetuation of global inequities. We focus on how the ethical imperative to promote the common good during public health emergencies can conflict with protecting the interests of biobank participants. We discuss how conducting biobank research under a waiver of informed consent during public health emergencies is ethically permissible, provided guidance is in place to prevent biopiracy and exploitation of vulnerable communities. We also highlight the need for biobank collaborations between LMICs and HICs to promote capacity building and benefit sharing. Finally, we offer guidance to promote the ethical oversight of biobanks and biobank research during the COVID-19 pandemic or other future public health emergencies. (shrink)

This manuscript summarizes the most common barriers to effective administrative preparedness and how to surmount them through the use of promising practices, strategies, and NACCHO developed resources focused on addressing unique jurisdictional requirements and needs.

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern (...) and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. (shrink)

In December 2006 there was an amendment to the Medicines for Human Use (Clinical Trials) Regulations 2004, the statutory instrument that translated the European directive into UK law. I will demonstrate how the European directive stifled much needed clinical research in urgent critical states whilst there is an international consensus that research in these situations be allowed. The amendments to the UK Medicines for Human Use (Clinical Trials) Regulations 2004 in allowing such exception have failed to preserve the high degree (...) of respect and protection of the participants' interest as reflected in the spirit of the numerous guidelines, conventions and laws appertaining to the ethics of research in clinical emergencies. (shrink)

The article discusses leadership enactment in medical emergencies. We draw on video recordings of simulated obstetric emergencies and investigate how senior clinicians ‘do being’ the leader discursively in the spatiomaterial context of the emergency room. We take an interactional analysis approach, combining conversation analysis and interactional sociolinguistics and look specifically into the ways in which professional roles do interactional control using directives and questions in the material space of the obstetric room. We discuss this interactional performance in relation (...) to the clinical performance of the teams. Our analysis shows that leadership in medical emergencies is multimodally achieved; professionals draw on discursive strategies, the affordances of material space, body and gaze orientation, which build on each other and converge in indexing leadership. Our findings highlight the situated nature of negotiating responsibility, illustrating that leadership in our context is claimed, projected and resisted discursively. We provide a typology of the functions of questions in the emergency encounter, and close the article by foregrounding the implications of our study and providing directions for further research. (shrink)

Journal of Religious Ethics, Volume 49, Issue 4, Page 739-767, December 2021.

Panic buying is a common phenomenon that occurs during public emergencies and has a significant undesirable impact on society. This research explored the effect of scarcity on panic buying and the role of perceived control and panic in this effect through big data, an online survey and behavior experiments in a real public emergency and simulative public emergencies. The findings showed that scarcity aggravates panic buying, and this aggravation effect is serially mediated by perceived control and panic. Moreover, (...) this serial mediation model is more suitable for public health emergencies. These findings enrich the understanding of panic buying and provide important enlightenment for guiding rational public behavior and managing public opinion during public emergencies. (shrink)

Some legal theorists deny that states can conceivably act extra-legally, in the sense of acting contrary to domestic law. This position finds its most robust articulation in the writings of Hans Kelsen, and has more recently been taken up by David Dyzenhaus in the context of his work on emergencies and legality. This paper seeks to demystify their arguments and, ultimately, contend that we can intelligibly speak of the state as a legal wrongdoer or a legally unauthorized actor.

COVID-19 continues to dominate 2020 and is likely to be a feature of our lives for some time to come. Given this, how should health systems respond ethically to the persistent challenges of responding to the ongoing impact of the pandemic? Relatedly, what ethical values should underpin the resetting of health services after the initial wave, knowing that local spikes and further waves now seem inevitable? In this editorial, we outline some of the ethical challenges confronting those running health services (...) as they try to resume non-COVID-related services, and the downstream ethical implications these have for healthcare professionals’ day-to-day decision making. This is a phase of recovery, resumption and renewal; a form of reset for health services.1 This reset phase will define the ‘new normal' for healthcare delivery, and it offers an opportunity to reimagine and change services for the better. There are difficulties, however, healthcare systems are already weakened by austerity and the first wave of COVID-19 and remain under stress as the pandemic continues. The reset period is operating alongside, rather than at the end, of the pandemic and this creates difficult ethical choices. ### Balancing the greater good with individual care Pandemics—and public health emergencies more generally—reinforce approaches to ethics that emphasise or derive from the interests of communities, rather than those grounded in the claims of the autonomous individual. The response has been to draw on more public health focused ethics, ‘if demand outstrips the ability to deliver to existing standards, more strictly utilitarian considerations will have to be applied, and decisions about how to meet the individual's need will give way to decisions about how to maximise overall benefit’.2 Alongside this, effective …. (shrink)

For risk and crisis communication in health emergencies and for the management of infodemics, now is the time to intervene. A time that precedes the arrival of the next health emergency and a time...

The particular dynamics of public health emergencies urge scientists and Ethics Committee (EC) members to change and adapt their operating procedures to function effectively. Despite having previous pandemic experiences, ethics committees were unprepared to adapt to COVID-19 pandemic challenges. This survey aims to learn and thoroughly discuss the most salient issues for ECs during the COVID-19 pandemic. The results indicate that the main problems faced by ECs were lack of/insufficient regulations, lack of data/experience/knowledge, sloppy review, poor research design, and (...) poor adaptation to quarantine measures. Coping with factors that threaten the autonomy and independence of ECs, the ethical dilemma regarding maximizing common good versus protecting the rights and well-being of study participants, comprehending the change in the context of vulnerable populations, and redefining the role of ECs to strengthen trust in science and vaccine confidence were outstanding issues. (shrink)

Michael Walzer has argued that nations fighting a just war may be permitted indiscriminate attacks on enemy noncombatants if they are genuinely necessary to avoid an imminent and morally disastrous defeat. Critics often challenge this "supreme emergency" exemption from just war principles by arguing that it is inconsistent with his critiques of utilitarianism, realism, and sub-state terrorism. While morally troubling, I argue that Walzer's doctrine is both tightly cabined and consistent with his meta-ethical pluralism, his emphasis on the value of (...) political community, and his doubts about abstract philosophy's ability to answer pressing political questions. (shrink)

Issues of resource allocationResource allocation, triageTriage, and rationingRationing decisions are common in the context of disasters and public healthPublic health emergencies, such as pandemics. However, to date, the majorityMajority of the literature focuses on an adult population with very little attention given to a pediatric population or to a population that may be mixed: adults and children. Furthermore, decisions of rationingRationing scarce resources do not only occur during disasters and other wide-scale emergencies. Such decisions are commonplace in pediatric (...) organ transplantation and can creep into areas of experimental medicine, such as xenotransplantation. This chapter explicates differences between pediatric and adult triageTriage decisions by first looking at the trifold issues of resource allocationResource allocation, triageTriage, and rationingRationing decisions mainly in the context of a disaster situation or public healthPublic health emergency. However, the issues of pediatric organ transplantation, health disparitiesHealth disparities, and experimental medicine will also be covered. (shrink)

A typical discussion around health reform in the U.S. focuses on how the nation can most effectively and efficiently extend insurance coverage to the rising number of people who have none. Furthermore, discussions about health care reform typically are centered on times of normalcy, when the health care system is not overly taxed and there is the luxury of time to think about everyday matters of health and health care, including health care services needed to prevent illness, treat conditions, and (...) address individual emergencies. But in light of the lessons learned over the past decade, it is also essential to consider how any reformed health care system will react to and mitigate the consequences of a public health emergency. (shrink)

I discuss the problem that Kant’s ethics seems to be incapable of capturing our strong intuition that emergencies create a context for actions that is very different from other cases of helping and from other opportunities to further obligatory ends. I argue that if we pay attention to how Kant grounds beneficence we see that distress and emergency function as constitutive concerns. They are vital to establishing the duty of beneficence in the first place, and they also guide the (...) application of duties to specific cases. Kant’s conception of imperfect duties to others, when understood correctly, offers a way to understand why emergencies are morally important, but also why other factors have a place in our moral reasoning. (shrink)

Law plays a critical role in all stages of a public health emergency, including planning, response, and recovery. Public health emergencies introduce health concerns at the population level through, for example, the emergence of a novel infectious disease. In the United States, at the federal, state, and local levels, laws provide an infrastructure for public health emergency preparedness and response efforts: they grant the government the ability to officially declare an emergency, authorize responders to act, and facilitate interjurisdictional coordination. (...) Law is perhaps most visible during an emergency when the president or a state's governor issues a disaster declaration establishing the temporal and geographic parameters for the response and making financial and other resources available. This legal authority has increasingly been used during the last decade. (shrink)

Purpose: The purposes of this study were to assess the knowledge, attitude, and practice of radiologists and paramedics regarding accident and emergency preparedness in hospitals in the southern region of the Kingdom of Saudi Arabia and how to improve their role. Materials and methods: This was a descriptive, cross‑sectional online survey that was carried out among radiologists and paramedics in the Kingdom of Saudi Arabia. A self-structured, close-ended questionnaire that was administered that consisted of 19 questions was included. The questionnaire (...) validity and reliability were evaluated for vetting and remarks. The questions were circulated through Google Forms, and it was circulated among the study participants through online mode. The data were collected systematically, and SPSS Statistics version 26.0 was used for data analysis Results: There were 139 responses, (77 specialist's radiology and 62 paramedics) participated in the study through Google Forms. In the study group, 84 (61.4%) were know the main steps for emergency response in major emergencies (p-value 0.000). Among the 19 questions used to assess the KAP, 12 questions were significant with a p-value less than 0.05. More than 72.6% agree the Management must be adequately prepared when emergencies and accidents occur. The respondents’ attitude toward emergency preparedness was generally positiveو Only a minority, that is, 43 (30.9%) of the respondents think it is possible for cooperation between radiologists and paramedics to interpret emergency cases and develop treatment plans in the emergency department. Conclusion: The level of knowledge was satisfactory among the radiologists and paramedics with a neutral level of attitudes, practice and knowledge regarding disaster preparedness. Follow-up research is essential to maximize the preparedness of the accident and emergency department. (shrink)